Elephant in the Room: Sano's Elbow

From my perspective, this has been a very positive offseason overall for the Twins. They have delivered some strong statements by handing out unprecedented contracts to multiple free agent pitchers, they made a smart move by officially transitioning Joe Mauer away from catcher, and several prospects turned in encouraging performances while participating in winter ball.

But all the while there has been a dark cloud looming overhead -- one that just won't seem to go away. That would be the condition of Miguel Sano's elbow. [PRBREAK][/PRBREAK]Sano missed some time in New Britain last July due to "arm fatigue," though not very much. The problem re-emerged while he was playing in the Dominican Winter League, where Sano was shut down after appearing in just two games due to elbow soreness.

At that point, concern started to build that the elite slugging prospect might need the dreaded Tommy John surgery. Those worries were briefly alleviated when La Velle E. Neal III blogged in mid-December that the third baseman had been examined in Ft. Myers and given a "clean bill of health."

Unfortunately, this thing won't go away. Asked recently about whether Sano will avoid going under the knife, Terry Ryan expressed what Mike Berardino described as "optimism but not certainty." Here's the quote:

"That would be our hope," Ryan said. "Right now we don't think it is (going to require surgery), but I can't tell you for sure until we crank him up a little more."

That's not exactly what we're hoping to hear at this stage of the offseason, especially after reports seemed to indicate that Sano was in the clear. The official diagnosis right now, per Berardino's article, is a "strained ulnar collateral ligament," which indicates that there is stretching or minor tearing in the UCL (though I believe "sprain" would be the more accurate term). In some cases these things clear up on their own, but often, the pain or deteriorating state of the ligament eventually leads to measures being taken.

If Sano's elbow keeps barking as he transitions into his workouts over the next month, it'll be tough to imagine that surgery can be avoided. We're on the verge of a seven-month period where the 20-year-old will be throwing on a daily basis and the organization can hardly expect him to be playing through constant pain, especially if there's real danger of worsening the condition of the ligament.

On the bright side, Tommy John surgery is significantly less serious for a position player than it is for a pitcher. Whereas the timeline for a hurler to return to full strength is generally between 12 and 14 months, many position players are able to return to the field in 6-8 months.

Still, that would obviously mean Sano would miss a majority -- if not all -- of the 2014 season, which would be a huge bummer considering that he stands a pretty good chance of breaking into the majors this year if healthy, following a dominant 2013 campaign in the minors.

As the Twins are fully dependent on prospects -- particularly the "Big Three" of Sano, Byron Buxton and Alex Meyer -- to lead their turnaround, losing one for a significant stretch of time in the prime of his development would be a heartbreaking turn, though sadly not uncharacteristic based on this snakebit franchise's recent history.

It's certainly possible that this is all much ado about nothing, and that Sano's elbow -- having been given several weeks to rest -- will feel fine once he ramps up his workouts in the coming weeks.

But when you step back and look at this situation as a whole, and you see an issue that first sprung up in July of last year and still hasn't cleared, it's difficult not to get an ominous feeling.

We should know more once Sano has his elbow re-examined in Ft. Myers. That's expected to happen soon.